Biomedical subjects
Publications and source records attributed to A Hopkins.
1. Gastric emptying has until now been regarded as exponential in form, but this pattern does not account for all phases of a meal.2. A pattern of emptying in which the square root of the volume of meal remaining declines linearly with time has been shown to account for the experimental results with less error.
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In the third of this six-part series, Alexandra Hopkins illustrates the changes in practices and responsibilities which will be typical for the prescribing nurse by drawing on the example of the nurse for the terminally ill. She emphasises that these changes are not synonymous with notions of 'the extended role'. They represent an entirely new concept in responsibility which will not be offered as an optional extra to groups of specialist community nurses but as part of their fundamental functions. Education remains the crucial factor in adequate preparation for the new role.
Successful management of acute myocardial infarction depends in the first instance on the patient recognising the symptoms and seeking help as quickly as possible. Once in hospital, fast track admission procedures and protocols for pain relief, early thrombolysis and appropriate ancillary measures (eg aspirin, i.v. betablockers) should be promptly instituted. Specialist advice and, if necessary, transfer to specialist unit should be considered if additional complications arise. Follow-up management after discharge from hospital requires cooperation between primary and secondary care to prolong survival by reducing risk factors, using aspirin, betablockers and angiotensin converting enzyme inhibitors and instituting a suitable rehabilitation programme. Audit measures are included in the report to help general practitioners and hospital doctors review their practice and assess it against the standards set.
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The rising number of emergency admissions and the increasing specialisation of medicine sometimes cause problems in the organisation of care for patients admitted as emergencies to medical beds. A multidisciplinary working group from general practice and the hospital sector identified five main areas in which problems occurred-communication, appropriateness of referral, finding beds, waiting by patients, and the organisation of clinical care. Guidelines and standards were suggested. We then carried out an audit of acute care in 42 hospitals with 400 or more acute beds. The most significant problems that emerged were the suboptimal involvement of consultants in acute care, the frequent lack of appropriateness of the admitting specialty to the patient's condition, and confusion about policies for admitting elderly patients.
Cardiac rehabilitation is a multidisciplinary activity and as such necessitates the development of audit systems that cut across professional boundaries. The objective of this paper is to describe the development and testing of an audit tool for cardiac rehabilitation. The tool, based on published guidelines, comprised three proformas: one for each patient entering a cardiac rehabilitation programme, one for a summary of a series of patients and one for the facilities available. The proformas were tested in three centres that were assessed as either 'high', 'moderate' or 'low' providers of cardiac rehabilitation. The cardiac rehabilitation programme coordinator of each centre examined a consecutive series of 30 patients' case notes and completed the proformas. The proformas were found to be clear and easy to use. Information was obtained that informed users of current practice and provided pointers to improvements in the provision of care. In conclusion, the cardiac rehabilitation audit tool proved to be effective in determining the documented evidence of practice, was better for determining the level of provision than a purely subjective judgement and provided information indicating an individual programme's strengths and weaknesses. This is the first attempt at producing an audit tool for cardiac rehabilitation. However, further work may be required in its refinement.
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